Journal of Pathology and Translational Medicine

Volume 41(2); April 2007

Original Articles

PAX2 Expression in Renal Dysplasia.: Yoon Hee Lee, Woo Hee Jung, Soon Won Hong, Hyeon Joo Jeong; Korean J Pathol. 2007;41(2):69-78.

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Abstract PDF: BACKGROUND
Renal dysplasia is the abnormal development of the kidney. The condition is usually detected in childhood along with other urinary tract anomalies, but can remain unnoticed until adulthood. It was recently reported that a PAX2 gene mutation plays a major role in the development of renal dysplasia. The aim of this study was to examine the expression of PAX2 in dysplastic kidneys of children and adults.
METHODS
A total of 30 cases diagnosed with renal dysplasia after a nephrectomy were examined. PAX2 expression was evaluated using immunohistochemistry. Apoptosis was detected using an Apop Tag detection kit.
RESULTS
In the dysplastic kidneys, there was strong PAX2 expression in the epithelia of the primitive ducts in both children and adults, but the degree was significantly lower in adults (p=0.007). However, the mesenchyme surrounding the primitive ducts of children showed stronger staining for the smooth muscle actin antibody and trichrome than the adults. The apoptosis index was significantly higher in the primitive duct epithelia than in the surrounding normal collecting duct epithelia (p=0.000).
CONCLUSIONS
PAX2 is overexpressed in the primitive ducts of renal dysplasia, which is sustained until adulthood and is associated with increased apoptosis. However, a decrease in PAX2 expression in the dysplastic epithelia and mesenchymal cuff of adults suggest a gradual regression of the dysplastic elements with time.

Immunohistochemical Analysis of Midkine Expression in Preinvasive and Invasive Squamous Cell Neoplasia of the Uterine Cervix.: Suk Jin Choi, Eun Seop Song, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 2007;41(2):79-86.

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Abstract PDF: BACKGROUND
Midkine (MK) is a member of the heparin-binding growth factor family. Overexpression of MK is observed not only in cancerous tissue but also in precancerous lesions of the colon and the prostate. Using immunohistochemical methods, we investigated MK expression in preinvasive and invasive neoplasia of the uterine cervix.
METHODS
We performed immunohistochemical analysis of archived cone biopsy and hysterectomy specimens from 161 squamous cell lesions of the uterine cervix (29 cervical intraepithelial neoplasia 1 (CIN1), 35 CIN2, 49 CIN3, 30 microinvasive squamous cell carcinomas (MIC), and 18 invasive squamous cell carcinoma). In addition, we examined if there is a correlation between MK expression and status of human papilloma virus infection determined by a commercially available DNA chip.
RESULTS
None of the normal cervical mucosa showed MK immunostaining. The level of MK expression gradually increased according to the histologic grade. Moderate and strong expressions were most frequently observed in cervical tissue with CIN3 and MIC. MK immunostaining was more accentuated in the invasive border of MIC.
CONCLUSION
MK may play a functional role in the disease progression of cervical squamous cell neoplasia.

Vimentin and Survivin Expression Rates as Prognostic Factors in Medulloblastoma.: Jae Yeon Seok, Se Hoon Kim, Yoon Hee Lee, Jieun Kwon, Tai Seung Kim; Korean J Pathol. 2007;41(2):87-94.

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Abstract PDF: BACKGROUND
A medulloblastoma is a primitive neuroepithelial tumor of the cerebellum that occurs in children and metastasizes through the cerebrospinal fluid. It is highly malignant and invasive, and the 5-year survival rate is only 60%. Surgical resection techniques, radiation, and chemotherapy have improved the overall survival but the patients suffer life-long cognitive dysfunctions or endocrine abnormalities as the side effects of treatment. Therefore it is essential to identify prognostic markers to determine the appropriate treatment strategy in order to minimize the side effects.
METHODS
This study evaluated the immunohistochemical differentiation and survival rate with synaptophysin, glial fibrillary acidic protein, epithelial membrane antigen, vimentin and primitive neuroepithelial marker nestin of 55 paraffin-embedded medulloblastomas, using a tissue microarray. The expression of survivin, the apoptotic inhibitor, and the survival rate with regard to the proliferation index of Ki-67 were also investigated.
RESULTS
The group testing positive to vimentin, a mesenchymal differentiation marker, had a worse prognosis and there was a strong correlation between vimentin expression and nestin expression. Patients with a survivin expression rate >35% had a significantly poorer clinical course and there was a correlation between the survivin expression rate and Ki-67 expression rate.
CONCLUSION
In conclusion, vimentin and survivin are negative prognostic markers in medulloblastomas.

The Expression of Telomerase Reverse Transcriptase Protein is an Independent Prognostic Marker in Early Stage Non-Small Cell Lung Carcinomas.: Ji Han Jung, Chan Kwon Jung, Ahwon Lee, Gyeongsin Park, Jinyoung Yoo, Kyo Young Lee; Korean J Pathol. 2007;41(2):95-102.

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Abstract PDF: BACKGROUND
The catalytic subunit of telomerase, hTERT (telomerase reverse transcriptase), is one of the most important components of telomerase, and performs a pivotal role in the mechanism underlying the regulation of telomerase activity in cellular immortalization and carcinogenesis. The principal objective of this study was to investigate hTERT expression in patients with non-small cell lung carcinomas (NSCLCs), and to evaluate its clinical significance and association with the expression of p16 and p53.
METHODS
Using tissue microarray, the protein expression profiles of hTERT, p16 and p53 were investigated via immunohistochemistry in 167 samples of NSCLCs.
RESULTS
Expression was observed in 54.5% (91/167) of the tumors, which were predominantly squamous cell carcinomas. Patients evidencing hTERT expression in their tumors exhibited significantly poorer survival rates than did patients without hTERT expression in early-stage NSCLCs (p=0.0125). According to the results of our Cox regression analysis, hTERT expression proved to be an independent prognostic factor (p=0.006), particularly for squamous cell carcinomas (p=0.019). hTERT expression was not correlated with p16 expression, but was rather associated with the expression of p53 (p=0.002).
CONCLUSIONS
Our results show that hTERT may perform a function in the progression of NSCLC, and that its detection may be useful in predicting the prognosis of NSCLC patients in the early stages of the disease, as well as in the development of a targeted therapy in these tumors.

Causes of Hydrops Fetalis: Analysis of 149 Autopsy Cases.: Ho chang Lee, Je G Chi, Sung Hye Park; Korean J Pathol. 2007;41(2):103-108.

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Abstract PDF: BACKGROUND
Hydrops fetalis is defined as abnormal accumulation of serous fluid in two or more fetal compartments, and this malady is known to be associated with various pathologic conditions.
METHODS
We collected 149 cases of hydrops fetalis out of 2,312 autopsies, and we tried to elaborate the underlying causes of hydrops fetalis. The diagnosis was based on the material from either antenatal termination or intrauterine death.
RESULTS
The relative incidence of hydrops fetalis was 6.44% of all the pediatric autopsies we performed. The gestational age was evenly distributed from 18 to 33 weeks, except for 30 to 31 weeks. There was no sex difference in the incidence of hydrops fetalis. The main causes were cardiovascular diseases (30.9%), cystic hygroma (13.4%), chromosomal anomaly (8.05%), thoracic conditions (7.38%), followed by urinary tract malformation (4.03%), infection (4.03%) and anemia (3.36%). The most common chromosomal anomaly was Turner syndrome and the second one was Down syndrome.
CONCLUSION
Since various conditions can be the cause of hydrops fetalis, pathologists should pay attention to elaborate the underlying causes in every single autopsy.

Expression of p73 in Non-small Cell Lung Carcinomas.: Ji Han Jung, Gyeongsin Park, Chan Kwon Jung, Hyun Joo Choi, Jinyoung Yoo, Seok Jin Kang, Kyo Young Lee; Korean J Pathol. 2007;41(2):109-115.

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Abstract PDF: BACKGROUND
The p73 is a recently identified homologue of the tumor suppressor gene, p53, and it has been found to induce apoptosis and inhibit cell proliferation. However, its role in the development of tumors is unclear. This study examined the expression of p73 in patients with non-small cell lung carcinomas (NSCLCs) to determine its clinical significance and association with the expressions of p53, pRb, and mdm2.
METHODS
A total of 183 NSCLCs were analyzed immunohistochemically using a tissue microarray.
RESULTS
The p73 protein was expressed in the cell nuclei in 156 (85.2%) out of the 183 cases. There was no correlation between the p73 expression and the clinicopathological variables. However, there was a correlation between the p73 expression and the mdm2 and pRb expressions. Multivariate Cox survival analysis identified tumor size and lymph node metastasis to be independent prognostic factors, but the p73 expression was not found to be associated with the patients' survival.
CONCLUSIONS
p73 is commonly expressed in NSCLC and it might, in conjunction with pRb and mdm2, be involved in the development of these tumors.

Case Reports

The Intestinal Type of Florid Cystitis Glandularis Mimics Bladder Tumor: A Case Report.: Young Soo Song, Ki Seok Jang, Si Hyong Jang, Kyueng Whan Min, Woong Na, Soon Young Song, Hong Sang Moon, Tchun Yong Lee, Seung Sam Paik; Korean J Pathol. 2007;41(2):116-118.

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Abstract PDF: Cystitis glandularis is a benign metaplastic proliferative lesion of the urinary bladder which usually occurs in the setting of chronic irritation and infection or in some cases as a congenital process. Sometimes it presents as a tumor mass-like florid lesion, grossly mimicking malignancy. We report a case of 59-year-old man with multiple mass lesions around the trigone and the neck portion, which suggested the possibility of malignancy in clinical and radiological evaluations. Final diagnosis was confirmed by transurethral resection. The surface urothelial lining was intact. The submucosa showed von Brunn's nests, cystitis glandularis and cystitis cystica in the edematous lamina propria. There were numerous glands lined by tall columnar, mucin producing epithelium without atypia, conforming to the appearance of the intestinal variant of cystitis glandularis. The cystitis glandularis may mimic a neoplasm on gross evaluation. The intestinal variant of cystitis glandularis is particularly likely to be problematic when florid.

Placental Findings of Listeria Monocytogenes Infection in Twin Pregnancy: A Case Report.: Dong Hoon Shin, Dong Eun Song, Kyu Rae Kim; Korean J Pathol. 2007;41(2):119-122.

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Abstract PDF: A Listeria monocytogenes infection is relatively rare in healthy adults. However, the chance of an infection increases almost 17 times in pregnancy due to changes in the immune function. A Listeria monocytogenes infection results in characteristic gross and microscopic features in the placenta, including multiple yellowish nodules showing microscopic intervillous abscess and intervillositis. We describe the placental findings of a Listeria monocytogenes infection that was complicated by maternal sepsis, myocarditis and congestive heart failure. The infection was discovered in the 34th week of a twin gestation in a 28 year-old woman. This case should emphasize the importance of this condition to pathologists. Antibiotic treatment was started based on the placental histologic findings before a maternal blood culture confirmed growth of Listeria monocytogenes. Both the mother and twin babies were healthy at the time of this report.

Parosteal Ossifying Lipoma of Femur: A Case Report.: Jae Seok Lee, Wan Hyung Cho, Ji Yoong Yu, Min Suk Kim, Jae Soo Koh; Korean J Pathol. 2007;41(2):123-126.

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Abstract PDF: Parosteal lipoma is a rare and generally asymptomatic benign tumor of mature adipose tissue that is located in direct apposition to the external surface of the bone. These tumors are occasionally associated with reactive changes in the underlying bone. The reactive bone formation is generally restricted to the base of the tumor, that is, near the periosteum. We recently experienced a case of parosteal lipoma in the proximal femur, which displayed exuberant bone and cartilage formation, and this led us to a misdiagnosis of chondroblastic osteosarcoma on the initial biopsy. We report here on this case with a special emphasis on making the differential diagnosis from osteosarcoma.

Undifferentiated Gallbladder Carcinoma with Osteoclast-like Giant Cells: A Case Report.: Yun Kyung Kang; Korean J Pathol. 2007;41(2):127-131.

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Abstract PDF: Undifferentiated carcinoma with osteoclast-like giant cells (OGCs) is the least common type of gallbladder carcinoma. Here, the author presents a case of undifferentiated gallbladder carcinoma with OGCs in an 81-year-old male patient. Grossly, the tumor was a 10x7 cm sized, polypoid, lumen-filling mass with extensive hemorrhage and necrosis. Microscopically, the tumor was composed of pleomorphic ovoid to spindle cells admixed with numerous OGCs. There was a minute focus of mucosal dysplasia and carcinoma in situ. Immunohistochemically, the mononuclear cells were positive for cytokeratin, p53 and Ki-67, while the OGCs were negative for these markers but positive for CD68. These findings support an epithelial origin for the ovoid to spindle cells and the nonneoplastic reactive histiocytic lineage of the OGCs.

Intra-thyroid Thyroglossal Duct Cyst: A Case Report.: Hyun Joo Choi, Ji Han Jung, Jinyoung Yoo, Seok Jin Kang, Kyo Young Lee, Chung Soo Chun, Bong Joo Kang, Eun Suk Cha; Korean J Pathol. 2007;41(2):132-134.

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Abstract PDF: Thyroglossal duct cysts develop in the persistent remnants of the thyroglossal tract between the origin of the thyroid at the foramen cecum and the final position of the thyroid gland. Thyroglossal duct cyst can present anywhere from the base of the tongue to the manubrium, but its occurrence within the thyroid gland is very rare. We report here on a 41-year-old woman who presented with a cystic thyroid nodule that was due to an intrathyroid thyroglossal duct cyst. The sonogram, showed a hypoechoic nodule that measured 0.7 x 0.6 cm in the left thyroid lobe. Left lobectomy of the thyroid gland was performed and microscopic examination revealed a cyst lined by non-keratinized squamous epithelium, which was consistent with a thyroglossal duct cyst in the thyroid gland. Intrathyroid thyroglossal duct cyst should be considered in the differential diagnosis of a cystic thyroid nodule. This is the first reported case of a intrathyroid thyroglossal duct cyst in a Korean adult.

Squamous Cell Carcinoma of the Cervix with Intraepithelial Extension to the Endometrium: A Case Report.: Bohng Hee Kim; Korean J Pathol. 2007;41(2):135-137.

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Abstract PDF: Squamous cell carcinoma (SCC) of the cervix with intraepithelial extension to the endometrium is a rare event, accounting for about 0.7% of all cervical SCC. Endometrial lesion has been considered as a direct extension of cervical cancer in the early reports, and this was confirmed in a recent molecular study. I report here on the case of a 56-year-old woman who had stage IIB SCC of the cervix with extension, in an in situ fashion, to the entire endometrium. HPV type 16 was detected via PCR in both the cervical and endometrial tumors.

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